Liver Disease Toolkit

Liver Disease banner

British Liver Trust logoLiver disease is one of the five most common causes of premature death in the UK and is the only major cause of death that has a year by year increasing incidence.

However, more than 90% of liver disease is preventable.

The aims of the BLT/RCGP Liver Priority Project are to raise awareness of liver disease as an increasingly important cause of morbidity and mortality in the UK and to provide resources to support its optimal management in primary care.

The toolkit is a resource that will grow. Please tell us what you would like to see in the toolkit via the details at the bottom of the page.

Resources for practitioners

This section contains articles and resources for primary care practitioners on liver disease, its impact, its risk factors and prevention, its early diagnosis and its management.

When you've used one of the resources, use the reflection template for your appraisal portfolio.

The project team is currently preparing resources for the following areas:

  • LFT blood testing and investigations in liver disease (summarising the British Society of Gastroenterology guidelines 2017)
  • Hepatocellular carcinoma
  • End of life care in liver disease [PDF]
  • Care after a transplant
  • Other viral hepatitis: A D and E
  • Hepatic encephalopathy
  • Hepatitis A and B immunisation
  • Other liver diseases (including autoimmune and metabolic diseases)

If there is an article you would like to see in the toolkit let us know via the link to the feedback page below.

Recommended Read Codes for primary care

Please view the links to see recommended Read Codes to use for liver disease. Read Codes are suggested for both SystmOne and EMIS/Vision users.

Top ten tips articles

These articles are produced by the RCGP and provide opportunities for 'bite-sized' learning. View the links to access top tips articles on liver disease.

Top ten tips cirrhosis in the over 16s

Practical implications for primary care: NICE guideline NG50. Cirrhosis in over 16s; assessment and management.

This top tips document [PDF] supports implementation of recommendations in the NICE guideline on cirrhosis in over 16s. National Institute for Health and Care Excellence July 2017

Top ten tips non-alcohol-related fatty liver disease

Practical implications for primary care: NICE guideline NG49. Non-alcoholic fatty liver disease assessment and management (2016)

This top tips document [PDF] supports implementation of recommendations in the NICE guideline on non-alcoholic fatty liver disease. National Institute for Health and Care Excellence June 2017

Top ten tips prolonged neonatal jaundice

When you've read one of the articles, please use the reflection template for your appraisal portfolio.

Personal learning reflection template [PDF]

Review your practice - Ideas for audit and reflection?

These links contain ideas and suggestions to help you reflect on your clinical practice relating to liver disease. Are you equipped to identify patients with risk factors for liver disease and to help them reduce their risk? Are you equipped to identify and manage early liver disease?

When you've used one of the resources, use the reflection template for your appraisal portfolio.

National guidance and information on liver disease

This section provides links to national guidance and resources focusing on the management of liver disease

British Liver Trust Resources for practitioners

The British Liver Trust (BLT) website has a section dedicated to healthcare professionals and researchers. There is information about:

All BLT information is written by, or rigorously assessed and reviewed by, medical specialists or other health care professionals and will be of value both to patients and practitioners. Many of these information documents are available in languages other than English.

The website has a range of other valuable information including how patients can access the BLT support line and information on patient support groups.

When you've read one of the guidelines or resources, use the reflection template for your appraisal portfolio.

Updates on the Liver Priority Programme

Organisations to support you and your patients

This section provides links to a range of organisations that work to prevent liver disease, to support those with liver disease, or provide resources and guidance to practitioners working with patients with liver disease.

British Liver Trust. The British Liver Trust is the leading UK liver disease charity for adults, providing information and support for professionals, patients and carers; promoting prevention and early diagnosis of liver disease; funding and championing research; and campaigning for better services. The Trust works with smaller diagnosis patient organisations and has links to all of these on its website. In addition the Trust has an anonymous love your liver health screener that assesses the risks posed by alcohol, obesity and viral hepatitis and provides a print out of what you need to do and if need be what to discuss with your GP.

Children's Liver Disease Foundation. The CLDF is a UK-wide charity that provides support, information research funds and a voice for all those affected by childhood liver disease.

Yellow Alert. Yellow alert is CLDF's prolonged jaundice in newborn babies awareness campaign. Yellow Alert promotes the early diagnosis and appropriate referral for liver disease in newly born infants.

Alcohol Concern. Alcohol Concern's aims are to help people concerned about their drinking by providing information and guidance, and to help professionals through training, projects and research.

Drinkline. Drinkline provides a national helpline to offer help and signposting for callers worried about their drinking, support for the family and friends of people who are drinking and links to information and self-help materials.

Alcohol Health Alliance. The Alcohol Health Alliance brings together more than 40 organisations that have a shared interest in reducing the damage caused to health by alcohol. Members include medical royal colleges, charities, patient representatives and alcohol health campaigners. Its aims are to highlight the rising levels of alcohol-related harm; propose evidence-based solutions to address the harms; and encourage decision makers to take positive action.

Obesity Health Alliance. The Obesity Health Alliance is a coalition of over 30 organisations who have joined together to fight obesity. Members include medical royal colleges, charities, campaigners and professional associations. The alliance works together to influence Government policy on overweight and obesity.

Hepatitis C Trust. The Hepatitis C Trust is a national UK charity supporting those with hepatitis C infection. It is a patient-led and patient-run organisation and most of its board, staff, and volunteers either have hepatitis C or have had it and have cleared it after treatment.

Hepatitis B positive. This organisation provides information for the public on hepatitis B infection.

Hepatitis Scotland. Hepatitis Scotland provides training for non-statutory organisations, information and support for patient involvement for those with hepatitis B or C infection in Scotland, and resources for health professionals.

British Association for the Study of the Liver. BASL is a multidisciplinary association with 850 members from medical, nursing and research backgrounds. It aims to advance knowledge about liver biology and pathology; disseminate research findings and promote clinical care of liver disease. Find out more about joining BASL.

British Liver Nurses Forum. The Forum is for nurses from all clinical areas and departments who seek to promote and develop the care of patients with liver disease. The Forum holds one national conference each year, and publishes twice yearly newsletters. In collaboration with the Royal College of Nursing and other stakeholders the Forum has developed a robust clinical competence framework.

British Society of Gastroenterology. The British Society of Gastroenterology promotes the practice and study of gastroenterology within the United Kingdom. It has over three thousand members including physicians, surgeons, pathologists, radiologists, scientists, nurses, dietitians, and others interested in the field. Internationally it is represented at World and European level.

The Primary Sclerosing Cholangitis Online Support Group is a group consisting of people with PSG and provides mutual support

Primary Care Society for Gastroenterology. The PCSG supports the practice of gastroenterology within primary care through providing guidelines, supporting research and educational events. Membership is free.

The RCGP is the professional membership body for family doctors in the UK and overseas. It is committed to improving patient care, clinical standards and GP training and offers resources for GPs in practice including CPD targeted towards liver disease.

Liver disease information for patients and carers

If you have a liver problem yourself, or you are a health professional and one of your patients is worried about developing liver disease; has had an abnormal liver function test; has been diagnosed or is caring for a loved one with a liver condition; or has questions about liver cancer you will need access to jargon-free, patient-friendly, reliable information that has been checked by experts.

This section of the toolkit provides signposts to these resources. Much of the information is detailed and will useful for health care professionals as well as patients.

General Information

Risk factors for liver disease

Liver disease often has no symptoms in the early stages. The British Liver Trust has developed a range of materials covering the risk factors for liver disease and the signs and symptoms of liver disease. They are free to order and include posters and leaflets for display in GP surgeries.

RCGP-liver-disease-information-for-patients-and-carers

Patient Leaflets on different liver conditions

The British Liver Trust has a full range of leaflets on the whole range of liver diseases that can be downloaded for free.

The full range of leaflets can be downloaded for free here  or your patient can order a free hard copy by calling 01425 481320.

The most popular leaflets include:

Information is also available on the website on all of the different types of liver disease

The British Liver Trust also runs a free patient Helpline run by nurses with liver expertise.

Helpline: 0800 652 7330 (10am to 3pm Monday to Friday)

Liver Cancer information

Hepatitis C Trust

The Hepatitis C Trust produces a range of materials.

They also run a Helpline on 0845 223 4424 or 020 7089 6221 (10.30am to 4.30pm Monday to Friday). Alternatively, you can email helpline@hepctrust.org.uk

Children's Liver diseases

The Children's Liver Disease Foundation has a range of suppport information and offers support on the different types of liver disease affecting children.

Local support groups and support groups for rarer types of liver disease

Innovation and best practice in liver disease

Examples of innovation and best practice in liver care

Many local teams have led innovative and exciting developments in the prevention and management of liver disease in their areas. Please follow the links to find out about some developments in liver disease management across the UK.

If you've been involved in innovative or best practice in the management of liver disease and you would like to share details of your project, please complete the pro forma and email it to circ@rcgp.org.uk

The Bolton Alcohol Project

Teams in Bolton have developed integrated and collaborative changes that led to:

  • the creation of a consultant-led hospital based alcohol care team that has improved the care and reduced admissions for alcohol-related conditions
  • a primary care project that has been highly successful in identifying alcohol problems through screening with the AUDIT-C test and signposting patients to early interventions

Liver health screening in Middlesbrough

Middlesbrough has developed a 'Live Well Centre'. The centre is a one-stop shop to support people in changing their lives for the better across a full spectrum of life issues. The project is specifically building in the identification of risk factors for liver disease together with signposting to further interventions as part of an opportunistic screening programme.

End of life care for patients with advanced liver disease

St Luke's Hospice, Basildon, has worked collaboratively with local secondary care hepatology services to create a Shared Care Liver Project designed to meet the unmet needs of patients with advanced liver disease and to improve end of life care.

The Scarred Liver Project Nottingham

The Scarred Liver Project has developed an effective community-based diagnostic pathway for identifying liver disease which stratifies patients using validated non-invasive tests. GPs can refer patients with a defined risk factor for chronic liver disease directly for transient elastography (Fibroscan) before considering referral to secondary care. The aims of the project include improving the early detection of liver disease and providing brief lifestyle interventions for those attending for screening.

The St Mary's Surgery Liver Project Southampton

The St Mary's Surgery Southampton recognised that the patients in their large inner city practice were likely to have a high prevalence of liver disease. Having been part of the ‘Locate’ project the practice worked with local liver specialists to improve their identification and management of liver disease through the development of local clinical pathways and through direct GP access to transient elastography (TE).

When you've read of the examples of innovation or best practice, use the reflection template for your appraisal portfolio.

Links to training resources

BLT/RCGP Liver Priority Programme e-modules. A suite of e-modules is currently being developed to support the Liver Priority Project. If you have any suggestions or requests for emodules that would be useful, please email circ@rcgp.org.uk

  • RCGP SMAH alcohol certificate course. This course helps practitioners to improve their understanding of alcohol-related problems and equip themselves with the skills and knowledge necessary to manage them. The course consists of a compulsory e-learning module followed by a face to face training day.  
  • HCV Action educational film: Detecting & managing hepatitis C in primary care. This educational resource was developed in a partnership between the RCGP, HCV Action and The Hepatitis C Trust, and is primarily aimed at GPs and other primary care staff. It aims to support the viewer by increasing their knowledge about the virus, and by building confidence in diagnosing people and supporting them through treatment.
  • British Association for the Study of the Liver. Access information regarding BASL organised events, BASL endorsed events and other educational events related to hepatology.
  • Primary Care Society for gastroenterology courses and conferences. The PCGS holds major educational events throughout the year, giving those involved in Primary Care a chance to hear from leading experts in gastroenterology and associated fields.
  • The British Liver Nurses' Forum Annual Conference.The BLNF has a major conference each year aimed at nurses and others working in the area of liver disease
  • Courses and conferences. The RCGP runs extensive resources of conferences, courses, events and e-learning modules, many of which are relevant to the management of liver disease.
  • RCGP Very Brief Advice training. This e-learning module is aimed at healthcare professionals who would like to promote behaviour change in their patients to reduce their cancer risk, though is applicable to patients with risks in other areas. The module highlights the links between cancer and smoking, obesity and alcohol and supports leaning in delivery of very brief advice to promote behaviour change.

When you've used one of the resources, use the reflection template for your appraisal portfolio

Resources for practices and practice nurses

RCGP-resources-for-practices-and-practice-nurses

As part of a national drive to inform more health care professionals (HCPs) about liver disease this page is designed to give you regular snapshots and updates on current projects, links to helpful websites and other news.

Background

The levels of morbidity and mortality associated with liver disease are increasing nationally.

The three major causes of liver disease in adults are alcohol-related liver disease, obesity and metabolic syndrome leading to non-alcohol-related liver disease, and viral hepatitis.

Updates and snapshots of interest to nurses:

1. RCN: Caring for people with liver disease: a competence framework for nursing

This framework was developed especially to support all HCPs in identifying patients with known liver disease, identifying those at risk of developing liver disease, promoting health livers and positive lifestyle choices, and to help increase practitioners’ skills and knowledge around managing liver disease. The framework gives examples of what evidence is needed to achieve each area of competence.

For practice nurses, competence 2 gives advice on signposting and supporting patients (and families) to deepen their understanding of their condition through patient education and health promotion.

Community nurses and matrons managing patients with long-term liver conditions may find it useful to use competence 6, working alongside and with the patient (and families), to address the psychological and social impact of their condition. This competence supports appropriate referral to drug and alcohol services, diabetes community teams and coordination of the patient’s care.

Of value to any community practitioner, competence 7.3 looks at managing the pharmacological treatments that may be used in treating patients with liver disease.

2. In order to help understand the needs of community and practice nurses there is an RCN ‘Caring in Practice’ project currently underway (run by Michelle Clayton and Lynda Greenslade).

This project aims to assess the educational needs of community and practice nurses in order to improve their management of patients with liver disease or who are at risk of developing liver disease.

Information will be gathered via a confidential questionnaire which will be available soon on this website (from early October). We encourage all practice and community nurses to complete the questionnaire.

Evaluation of responses to the questionnaire will lead onto a study day to address the training needs identified and applying them to the competence framework.

The project will also:

  • use social media to deliver bit size chunks of liver learning, relating it to the competence framework
  • support nurses in developing skills through practice education sheets
  • improve the secondary and primary care pathways for patients with liver disease.

3. The launch of a new liver nursing group called British Liver Nurses Association (BLNA) linked to British Association for the Study of the Liver (BASL) this Sept 2017.

The aims of the BLNA will be to:

  • provide one voice for all nurses in primary and secondary care looking after those at risk of or who have liver disease
  • work across all four countries in the UK to promote and raise awareness of liver nursing
  • work at national and international level to improve the care of patients at risk of or with liver disease
  • give a voice to our patients and their families at local and national level to promote equitable access to liver care.

4. Future Plans for developing nursing for those at risk of or with liver disease

  • Respond to community and practice nurses’ needs for liver education and support the development of skills needed
  • Develop the right educational and support materials and tools for all.
  • Use links to the RCN forums to find out what additional support is needed and use those forums to network and share learning and education
  • Develop patient-specific care plans for patients as they leave hospital that are available for community services

Resources for commissioners

This section provides links to resources specifically aimed at commissioners.

Resources are currently in development for this page.

If you have any suggestions or requests for resources that would be useful, please go to the feedback page.

A financial case for action on liver disease has been developed by the Foundation for Liver Research and this report has been endorsed by the lancet commission on liver disease.

The British Society of Gastroenterology has provided several commissioning reports relating to liver disease and its management:

Scotland

There is public health information for Scotland relating to:

Wales

There is information on the prevalence of a range of liver diseases in Wales.

England

The Foundation for Liver Research has compiled customised liver disease profiles for each of the 533 parliamentary constituencies in England.

Give your feedback and suggestions

This toolkit has been developed in partnership between the RCGP Clinical Innovation and Research Centre and the British Liver Trust. 

Please send any feedback or suggestions to circ@rcgp.org.uk

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